Regional update - AHPRA Annual Report 2015/16

AHPRA Annual Report 2015/16

Regional update

AHPRA’s operational network includes offices in each capital city, which are responsible for the efficient and effective delivery of AHPRA’s core regulatory functions under the National Law. They also provide leadership and strategic direction in developing and delivering AHPRA’s operational policy and procedures.

These offices work directly with a variety of local stakeholders and support the local boards and committees. They are responsible for operational performance across our regulatory functions and implementing national policies and procedures. They are committed to continuously improving and quality-assuring our operational processes, and increasing efficiency and effectiveness. A number of regulatory services are organised across offices to improve overall service delivery.

Following are highlights from each of AHPRA’s state and territory offices, setting out the progress made this year. More detailed information can be found in the state and territory summary reports, which can an found on our Downloads page.

Australian Capital Territory

The Australian Capital Territory (ACT) office’s focus over the past 12 months has been collaboration and on building new ways of working together to ensure a consistent approach. ‘One team, one way’ has been the aspiration, and the Canberra and Hobart registration teams now function as one team, using the same process to receive and allocate the caseload of applications. This new process has been digitised to cut down on paperwork and save time.

Stakeholder engagement is also a priority. We have held meetings with the ACT Health Services Commissioner (HSC), the ACT Civil and Administrative Tribunal, the Australian Medical Association, the Chief Pharmacist and Pharmacy Guild. We have also continued to present on registration requirements and Boardrelated standards to local universities and major health employers, and on notifications to local professional associations.

In June, as part of a national tour, the Nursing and Midwifery Board of Australia held a public forum for ACT practitioners and other stakeholders, such as professional associations, unions and nursing educators.

Another major focus for the ACT office is training and improving the quality of decision-making. Staff worked closely with the state boards to introduce new processes in implementing decisions.

Mr Bob Bradford was Territory Manager of the ACT office until October 2015 when Ms Catherine Miedecke was appointed Acting Territory Manager.

ACT regulatory data 2015/16

The number of registered practitioners in the ACT has increased to 11,362, which is an increase of 384 (3.5% growth) from last year. This represents 1.7% of all registered health practitioners nationally.

Registration applications received increased by 20.5%, with 1,134 new applications for 2015/16.

Notifications received about ACT practitioners in 2015/16 increased by 15.7%, totalling 206 compared with 178 in the previous year. This represents 3.4% of all notifications received by AHPRA in 2015/16 (excluding HPCA). There was a national increase of 19.7% in notifications received across all jurisdictions (including those managed by the HPCA).

The number of open notifications at end of June 2016 was four less than the previous year (110 at end of June 2016, compared with 114 at the end of the 2014/15 year).

The percentage of the ACT registrant base with notifications received in 2015/16 was 1.8%, 0.3% higher than the national percentage.

At the end of 2015/16, there were 117 cases under active compliance monitoring in the ACT.

Noting that the total numbers are relatively low, the ACT received 20 new complaints about possible statutory offences in 2015/16, an increase of 100% on the previous year. Fifteen statutory offences were closed during 2015/16, an increase on the previous year of 114.3%. Almost all new matters related to title protection or advertising concerns.

New South Wales

The NSW office heightened its focus on achieving greater efficiencies in core processes, and collaborating and engaging with stakeholders.

As NSW is a co-regulatory jurisdiction, the primary role of this office is managing registrations, including managing 27.9% of the applications for registration that are received nationally. A new process was implemented to streamline the way registration applications are assessed. The entire application assessment phase is now undertaken electronically with nothing printed onto paper. This has resulted in:

A new, paper-light process was also introduced to improve the preparation of board and committee papers.

The NSW and Western Australia (WA) offices are AHPRA’s central assessment and processing centres for registration applications from internationally qualified nurses and midwives (IQNM). During the past year, we collaborated with the WA office to train staff working on IQNM applications. This has resulted in more timely assessments for international nurses and midwives seeking to practise in Australia. The two offices received more than 3,550 applications and completed just over 3,450 assessments.

This office also continues to deliver the national practitioner audit function and assisted all 14 National Boards with audits during 2015/16. Audits are tailored to the needs, practice requirements and, where applicable, cultural sensitivities of each Board. For example, when engaging with registrants of the Aboriginal and Torres Strait Islander Health Practice Board, members of the audit team use culturally sensitive language and endeavour to engage personally with the registrants to make the audit experience less formal.

The co-regulatory model in NSW involves continual collaboration between AHPRA, the National Boards and their committees, the various health professional councils, the Health Professional Councils Authority (HPCA) and the NSW Health Care Complaints Commission (HCCC). A memorandum of understanding was developed to confirm the relationships, roles and responsibilities of AHPRA and the HPCA when exchanging information relevant to regulatory matters under the National Law.

Mr Shane Dann was State Manager of the NSW office until April 2016 when Mr Peter Freeman was appointed Acting State Manager.

NSW registration data 2015/16

The number of registered practitioners in NSW increased to 190,986, which is 5,739 (or 3.1%) higher than last year. NSW registrants represent 29% of all registered health practitioners nationally.

There were 18,224 applications for registration during 2015/16, a 6% increase on 2014/15 figures.

AHPRA does not manage notifications in NSW. Notifications relating to health, performance or conduct occurring in NSW are managed by the 14 professional councils (supported by the HPCA), in consultation with the HCCC. However, we managed 94 notifications where a registrant’s principal place of practice was listed as NSW and the specific health, performance or conduct issue that led to the notification occurred in a jurisdiction other than NSW. See Table N2.

The percentage of the NSW registrant base with notifications during 2015/16 (including those managed by the HPCA) was 2.2%, which is 0.7% higher than the national average.

At the end of 2015/16, there were 1,381 cases under active compliance monitoring in NSW.

The state received 345 new complaints about possible statutory offences this year, a notable increase of 348.1% on the 77 received in the previous year. Almost all the new matters related to the use of protected titles or advertising concerns. In particular, a number of bulk complaints were received about potential breaches of the National Law in relation to advertising. Despite the increase in volume, 177 statutory offences were closed during the year, which represents a 142.5% increase on the number of matters closed in the previous year.

Northern Territory

Strengthening relationships with our stakeholders was an important focus for the Northern Territory (NT) office and the local boards and committees during the year. We held regular stakeholder meetings, presentations and events, and supported stakeholder engagement activities associated with hosting meetings of National Boards and the Agency Management Committee.

W

e continued our strong emphasis on improving how we manage notifications. This included participating in the pilot of a decision-making matrix for allocating matters between the National Boards and the health complaints entities (HCEs). The pilot involved AHPRA’s NT, WA and Victorian offices and the HCEs in those jurisdictions. The resulting decisionmaking tool and protocols help us determine which notifications will be handled by AHPRA and the Boards, and which will be actioned by an HCE.

In partnership with the new NT Health and Community Services Commissioner, we completed a significant body of work to redesign the consultation process between our office and the Commission. This has considerably improved how we communicate about new notifications and complaints, making our interactions and the joint decision-making process more efficient, effective and transparent.

The NT office manages all the registration applications AHPRA receives for the Aboriginal and Torres Strait Islander health practice profession and provides secretariat support to the Registration and Notifications Committee of the Aboriginal and Torres Strait Islander Health Practitioner Board of Australia (the Board). The grandparenting provisions of the National Law (section 303) for this profession ceased to apply from the end of June 2015. There was a dramatic surge in registration applications in the final weeks before the provisions expired, with the resulting increase in workload extending well into this reporting year.

The number of registered Aboriginal and Torres Strait Islander health practitioners increased by well over 50% by the end of June 2016, mainly as a result of the increase in applications under the grandparenting provisions. The geographic distribution of registered practitioners has also significantly improved.

We provided ongoing support for the Aboriginal and Torres Strait Islander health practice profession during the year, including:

The NT team also continued to provide wellinformed advice and support to other boards and committees in relation to the special challenges facing health practitioners who work in remote areas and care for mostly Indigenous patients.

NT registrations staff took on additional responsibilities during the year for processing physiotherapy applications for NSW, Tasmania and the ACT, and provided a quality assurance process for psychology registration papers in the NT, South Australia and WA.

Ms Jill Huck was the Territory Manager of the NT office during 2015/16.

NT regulatory data 2015/16

The NT recorded 3.2% growth in the number of registered practitioners this year, with total registrations rising by 217 to 6,913. This represents 1.1% of all registered health practitioners nationally.

We received 673 registration applications, which is 6% more than we received in 2014/15.

The number of notifications received about NT practitioners decreased by 16.3%, to 123, compared with 147 in the previous year. This represents 2% of all notifications received by AHPRA in 2015/16 (excluding those managed by the HPCA).

There were 68 open notifications at the end of the financial year, which is 16 fewer than at the same time last year.

The percentage of the NT registrant base subject to notifications in 2015/16 was 1.8%, which is 0.3% higher than the national percentage.

As at 30 June 2016, there were 55 cases under active compliance monitoring in the NT, 19 fewer than at the end of 2014/15.

Noting that the total numbers are relatively small, the NT received 11 new complaints about possible statutory offences this year, an increase of 120% on the previous year. Almost all new matters related to the use of protected titles or advertising concerns. Ten statutory offences were closed, which was an increase of 150%.

Queensland

The Queensland office of AHPRA and the Boards has continued to work closely with the Office of the Health Ombudsman (OHO) to ensure that notifications about health practitioners are managed in a way that offers the best protection to the health and safety of the Queensland community. Improvements have been made to the timeliness of notification referrals and the information that is collected by the OHO prior to referral, to reduce time frames and duplication.

The number of notifications referred to AHPRA and National Boards by the OHO more than doubled this year, compared with 2014/15 (see regulatory data below). This increase provided the impetus to explore new ways to manage notifications and leverage the benefits of being a national organisation.

We continue to communicate and collaborate with the OHO on a regular basis to further streamline our operations, share information and find opportunities to better manage the regulation of health practitioners. The OHO acknowledged in AHPRA and the national boards quarterly report: health, conduct and performance functions report (June 2016) the ‘consistent willingness and immeasurable efforts of AHPRA’ to collaborate with the office.

While many improvements have been made to the co-regulatory arrangements since they were established on 1 July 2014, there is still room for further improvement, specifically to reduce duplication, improve efficiency, ensure that data are consistently captured and to further develop a shared understanding of regulatory thresholds.

We continue to place importance on working with our stakeholders and have regularly met with them and taken up every opportunity to share information about the National Scheme. We value the feedback we receive and have worked hard to build and maintain these important relationships.

Our core values of service, achievement and collaboration have provided the foundation for our work in 2015/16. We’ve streamlined business processes and maximised the use of our improved systems and reporting capability throughout the Qld office. Our performance improvements have been driven by a highly capable and dedicated team, who have demonstrated their willingness and ability to respond to challenges in a professional and purposeful way.

Ms Rose Kent was State Manager of the Queensland office during 2015/16.

Queensland regulatory data 2015/16

The number of registered practitioners in Queensland has increased to 127,376, an increase of 5,588 (4.6% growth) from last year. This represents 19.4% of all registered health practitioners nationally.

Applications received for registration increased by 6.6% with 12,957 new applications received for 2015/16.

The OHO receives all health complaints in Queensland, including those about registered health practitioners, and decides whether the complaint:

The number of notifications relating to Queensland practitioners that the OHO referred to AHPRA and the National Boards in 2015/16 increased by 105.5% to 1,919, compared with 934 referrals in the previous year. This represents 31.7% of notifications received by AHPRA nationally in 2015/16 (excluding HPCA); significantly more than the national increase of 19.7% of (including those managed by the HPCA).

Due to this increase in matters referred by the OHO, there was also a 72% increase in the number of open notifications as at the end of June 2016 (1,288, compared with 749 at the end of the 2014/15 year).

The percentage of the Queensland registrant base with notifications received in 2015/16 was 1.5%, consistent with the national percentage.

At the end of 2015/16, there were 1,078 cases under active compliance monitoring in Queensland.

Queensland received 228 new complaints about possible statutory offences this year, an increase of 117.1% on the previous year. During 2015/16, 87 statutory offences were closed, a decrease of 7.5%. Almost all new matters related to title protections or advertising concerns.

South Australia

The end of grandparenting provisions for the Chinese medicine profession on 30 June 2015 had a significant impact on the South Australia (SA) office’s workload during 2015/16. This office is responsible for managing all the registration applications AHPRA receives from existing Chinese medicine practitioners under the grandparenting provisions of the National Law (section 303) and from internationally qualified applicants.

The huge number of applications received towards the close of grandparenting amounted to about 20 times the volume usually processed by this office. Most submissions arrived in the final four weeks. They came from 580 individuals and contained approximately 1,100 separate applications under the three areas of practice requiring registration in this profession: acupuncture, Chinese herbal medicine and Chinese herbal dispensing.

We increased the capacity of our small registration team and introduced a number of procedural improvements to manage the influx of complex applications and provide additional support to the Chinese Medicine Board of Australia during this busy transition period.

Our notifications and board services teams supported the introduction of an Immediate Action Committee for the SA Board of the Nursing and Midwifery Board of Australia (Board). The committee enables the Board to quickly act on new notifications that may pose a significant risk to public safety and therefore warrant immediate action. Board members are rostered on a rotating basis to attend the weekly standing committee, if required. A similar committee structure was introduced the year before by the SA Board of the Medical Board of Australia, to expedite its handling of serious notifications.

Engaging with stakeholders was another strong area of activity for the SA office during the year. We held regular meetings with representatives from the office of the Health and Community Services Complaints Commissioner, the SA Chief Medical Officer, the SA Chief Nurse, and the SA branches of the Australian Medical Association, the Australian Dental Association, the Australian Nursing and Midwifery Federation, Medical Insurance Group Australia and Avant. These meetings enabled us to discuss issues of mutual interest in an informal and collegiate manner, including sharing information about emerging trends in notifications and potential public safety concerns.

Senior staff from the SA office delivered 25 education and training sessions on behalf of the National Boards to practitioners and final-year students in nursing and midwifery, medicine, psychology, Chinese medicine and occupational therapy. Topics were tailored to the needs of each profession and included how to meet continuing professional development requirements and maintaining a portfolio, what constitutes notifiable behaviour, and explaining practitioners’ obligations under the National Law. We also spoke at the annual Adelaide forum of the National Aboriginal and Torres Strait Islander Health Workers Association about the importance and benefits of being registered under the National Scheme.

We achieved a large number of successful disciplinary and statutory offence prosecutions, and also introduced changes to our legal service model after successfully piloting an approach that involves insourcing legal work associated with tribunal matters.

Dr Richenda Webb was State Manager of the SA office during 2015/16.

SA regulatory data 2015/16

As at 30 June 2016, the number of registered practitioners based in SA was 53,119, an increase of 927 (or 1.8% growth) on last year. SA has 8.1% of all registered health practitioners nationally.

Applications for registration increased by 0.8%, with 4,741 new applications received during the year.

There were 808 notifications about practitioners with a principal place of practice in SA, which is 23.4% more than were received in 2014/15. This was slightly above the national increase in notifications of 19.7% recorded across all jurisdictions. SA’s notifications represent 13.3% of all those received by AHPRA in 2015/16 (excluding those managed by the HPCA).

The number of open notifications at the end of June 2016 was 118 greater than last year (564, compared with 446 at the end of 2014/15).

The percentage of the SA registrant base with notifications this year was 1.5%, consistent with the national percentage.

There were 452 cases under active compliance monitoring in SA at the end of the year. SA received 51 new complaints about possible statutory offences this year, almost all of which related to the use of protected titles or advertising concerns. This represented an increase of 21.4% on last year. We closed 27 statutory offences, which was a decrease of 30.8% on 2014/15 results.

Tasmania

The Tasmanian Board of the Medical Board of Australia, along with the other state boards, has this year cemented the gains made last year in engaging with external stakeholders. Our stakeholder engagement program includes presentations at monthly board meetings by the Office of the Health Complaints Commissioner, Advocacy Tasmania, Health Recruitment Plus, Professional Services Review and Clinical Leadership at Deakin University.

Individual Boards have also ramped up their stakeholder engagement and professional development programs in Tasmania this year. In particular, the Tasmanian Board of the Nursing and Midwifery Board of Australia has encouraged presentations from various state health organisations at its monthly board meetings.

We have also shared various professional development opportunities this year. For example, the Nursing and Midwifery Board discussed end-of-life care plans and heard from the Public Guardian about its role.

This year representatives from our office have attended various stakeholder forums to share information about the National Scheme and, when relevant, profession-specific issues. For example, significant work was undertaken to ensure that employers and medical recruiters were wellinformed about new supervision requirements published by the Medical Board of Australia. Staff regularly conduct briefings for new and transitioning practitioners, including first-year medical students, intern medical practitioners, new provisional psychologists and nursing students and graduates.

A large focus for the office was on developing the functional capabilities of the ACT and Tasmanian offices to work as one team across notifications and registrations. Staff have travelled and worked between the two offices and we have collaborated on new common processes.

Ms Catherine Miedecke was State Manager of the Tasmania office during 2015/16.

Tasmanian regulatory data 2015/16

The number of registered practitioners in Tasmania has increased to 14,123, an increase of 237 (1.7% growth) from last year. This represents 2.2% of all registered health practitioners nationally.

Applications received for registration increased by 6.2% with 1,137 new applications received in 2015/16.

Notifications received relating to practitioners with a principal place of practice in Tasmania in 2015/16 increased by 12.6% totalling 242, compared with 215 in the previous year. This represents 4% of all notifications received by AHPRA in 2015/16 (excluding HPCA). There was a national increase of 19.7% in notifications received across all jurisdictions (including those managed by the HPCA).

The number of open notifications at end of June 2016 was 13 fewer than the previous year (106 at end of June 2016, compared with 119 at the end of the 2014/15 year).

The percentage of the Tasmanian registrant base that were the subject of notifications in 2015/16 was 1.7% (0.2% higher than the national percentage).

At the end of 2015/16, there were 105 cases under active compliance monitoring in Tasmania.

Tasmania received 13 new complaints about possible statutory offences this year, an increase of 225% on the previous year. Fourteen statutory offences were closed during 2015/16, an increase of 250%. Almost all new matters related to title protections or advertising concerns.

Victoria

The key focus for the Victorian office this year has been to strengthen performance. We have developed strategies to ensure a strong culture of continuous improvement, which reflects AHPRA’s values of service, achievement and collaboration.

In late 2015, AHPRA commissioned KPMG to review notifications systems and processes in the Victorian office. KPMG examined the effectiveness of changes that had already been implemented to improve notifications performance, and identified areas for ongoing attention. The review addressed concerns around a notification that took too long to finalise in Victoria.

Initiatives have been introduced throughout 2015/16 to ensure an appropriate balance between the interests of patients, public safety and the rights of practitioners under investigation. A stronger approach to information sharing has been developed, particularly with the Department of Health and Human Services, as have new protocols for information sharing under provisions in the National Law.

The Victorian office launched a national pilot to improve risk assessment of new notifications. A new national role of notifications liaison officer was also piloted, which has informed significant enhancements to the receipt and assessment of notifications, and communication with notifiers and practitioners. The legal team has helped to significantly reduce the number of matters waiting for extended periods to be heard in tribunal or by a panel.

In collaboration with the NSW office, the Victorian registration team managed a major project to process new graduate applications for medical, nursing, midwifery and physiotherapy. Over a fivemonth period, the team finalised nearly 10,000 graduate registration applications, ensuring practitioners were ready to commence internships and graduate programs in a timely manner.

Dr Mary Russell was the State Manager of the Victorian office during 2015/16.

Victorian regulatory data 2015/16

The number of registered practitioners in Victoria has increased to 169,478, an increase of 5,154 (3.1% growth) from last year. This represents 25.8% of all registered health practitioners nationally.

Applications received for registration increased by 8.9% with 15,799 new applications for 2015/16.

Notifications received relating to practitioners with a principle place of practice in Victoria saw a marginal decrease of 0.2%, totalling 1,886 in 2015/16, compared with 1,889 last year. This represents 31.1% of all notifications received by AHPRA in 2015/16 (excluding HPCA). There was a national increase of 19.7% in notifications received across all jurisdictions (including those managed by the HPCA).

The number of open notifications at end of June 2016 was 142 greater than the previous year (1,082 at end of June 2016, compared with 940 at the end of the 2014/15 year).

The percentage of the Victorian registrant base with notifications received in 2015/16 was 1.1% (0.4% lower than the national percentage).

At the end of 2015/16, there were 1,032 cases under active compliance monitoring in Victoria.

Victoria received 298 new complaints about possible statutory offences this year, an increase of 213.7% on the previous year. Sixty-three statutory offences were closed during of 2015/16, a decrease of 43.8%. Almost all new matters related to title protections or advertising concerns.

Western Australia

The notifications and legal teams in the Western Australia (WA) office worked closely together during the year to expedite the handling of notifications and disciplinary matters.

We intensified our focus on new notifications that involve a potential risk to the public and therefore warrant a Board’s immediate attention. New notifications that arrive with sufficient explanatory information from the outset are also brought before the relevant Board as quickly as possible. And we now provide legal advice directly to the Boards at the time a decision is made. These changes have improved our internal processes and the timing of decisions made by the Boards, with flow-on benefits to the notifiers and practitioners involved.

Together with health complaints commissioners from our own state, the NT, SA, Tasmania and Victoria, and a representative from the Chairs of National Boards and AHPRA, we participated in a national working group and pilot project to improve how new notifications are managed and allocated. The initial focus was on developing a process for identifying the most appropriate entity to handle a notification, as well as improving how we communicate with notifiers about the roles of each organisation.

Our WA compliance team has been monitoring the conditions on an increasing number of practitioners’ registrations. This increase is partly due to efforts to reduce the time taken to conclude notifications where restrictions need to be applied to practitioners’ registrations, and partly due to new requirements for monitoring prohibited practitioners.

Registration teams from the WA and NSW offices combined efforts to efficiently process complex registration applications from practitioners with an international nursing or midwifery qualification. We collectively assessed more than 3,450 applications, reducing the previous processing time by half.

We participated in 170 external stakeholder activities, engaging with approximately 50 different organisations about registration standards, notification processes and other issues related to the National Scheme. These stakeholders included the Health Consumers Council (WA), the Health and Disability Services Complaints Office, public and private hospitals, universities and other health education providers, and government and non-government health agencies. One of these events was a graduation ceremony for Indigenous enrolled nurses studying with Marr Mooditj Training, which we were invited to attend to field questions from new graduates.

Our office is coordinating a program to support easier collaboration and efficiencies across AHPRA’s national network of offices. The initiative involves establishing a ‘smart’ working environment by maximising the use of modern telecommunications and computing solutions combined with cuttingedge office design.

Our quality assurance committee continued to meet every two months and implemented numerous changes across all functions of the office. Our compliance with AHPRA’s internal policies was continually monitored and maintained.

Adjunct Associate Professor Robyn Collins was State Manager of the WA office during 2015/16.

WA regulatory data 2015/16

The number of registered practitioners in WA grew by 1,796, or 2.7%, to 67,384 this year. This represents 10.3% of all registered health practitioners nationally.

Applications for registration decreased by 0.8%, with 6,643 new applications received during the year.

There was a 5.3% drop in notifications received about practitioners with a principal place of practice in WA – 718 notifications were received this year, compared with 758 in 2014/15. This represents 11.9% of all notifications received by AHPRA in 2015/16 (excluding those managed by the HPCA).

The number of open notifications at the end of June 2016 was 495, which was 59 more than at the end of the previous year.

The percentage of the WA registrant base with notifications in 2015/16 was 1.1%, 0.4% lower than the national percentage.

At the end of the year, 635 cases were under active compliance monitoring in WA.

WA received 112 new complaints about possible statutory offences this year, an increase of 166.7% on the previous year. Almost all new matters related to the use of protected titles or advertising concerns. Fifty-two statutory offences were closed, which was 37.3% fewer than last year.